■ Complaints by nurses in California and Minnesota center on better nurse-patient ratios and pension benefits.

Approximately 12,000 nurses represented by the Minnesota Nurses Assn. and working at 14 hospitals in Minneapolis and St. Paul went on strike for 24 hours on June 10 after contract negotiations broke down. That job action might not be their last.

On the same date, another strike against five University of California medical centers by the California Nurses Assn., which could have involved 11,000 nurses, was temporarily blocked by the courts. Protests were held, but nurses stayed on the job.

Those affiliated with the unions say they are seeking better nurse-to-patient ratios and no contraction of defined-benefit pension plans.

"Studies show better staffing improves outcomes," said Cindy Olson, RN, a member of the MNA's negotiating team and an ICU nurse at HealthEast Care System in St. Paul, Minn. "[The hospitals] refuse to address staffing levels."

The Minnesota Nurses Assn. held a vote June 21 on whether to strike again, this time for an indefinite period. Approximately 84% voted to authorize an open-ended strike if a contract agreement cannot be reached. (See clarification)

Rallies are continuing in California, and courts there are holding hearings as to whether nurses will be able to strike in that state.

Those speaking for some of the affected hospitals, however, say they suspect these incidents also may be connected to the formation of a new national union for nurses. Both the Minnesota and California Nurses Assn. are members of National Nurses United, which was formed in December 2009 and has more than 150,000 members. The organization is affiliated with the AFL-CIO.

Union activity in the health care setting has inched upward over the past few years, countering a downward trend in other industries. Experts say this was driven primarily by increased organization of registered nurses and other nonphysician staff.